[!TIP] Info: If a patient has Addison's disease, evaluate for the presence of primary cause for Addison's OR presence of APS (Autoimmune polyglandular disease)

[!TIP] mnemonic for causes of hypoadrenalism
Infection
Infiltration
Immune(autoimmune)
infarction
inherited (adrenoleukodystrophy)
iatrogenic

• Type 1 DM and/or autoimmune thyroid diseases
• Type 1 autoimmune polyendocrinopathy is causes mucocutaneous candiasis and hypoparathyroidism (see [[passMedicine Summaries#Autoimmune polyglandular syndrome]]

GVHD arises when immune cells transplanted from a non-identical donor graft into the recipient (host), recognize the host cells as "foreign," thereby initiate a graft-versus-host reaction.

"Successful transplantation requires that the donor immune system develop tolerance to these alloantigens, while maintaining the ability to recognize and respond to foreign antigens, such as microorganisms or tumor cells."

GVHD is responsible for upto 50% of post transplant mortality.
Management of GVHD:
All patients receiving haematopoietic stem cell transplant are given prophylaxis with cyclorporine and methotrexate.
If GVHD develops, mainstay of treatment is with steroids.
Source

Transfusion associated graft Vs. host disease

"There are five medically important genera of gram-positive rods: Bacillus, Clostridium, Corynebacterium, Listeria, and Gardnerella."

Bacterial spore formation

• One of the commonest coping mechanisms used by bacterial to deal with stress.
• Spores have minimal metabolism and respiration.
• Bacillus and Colistridium form endospores.
  • Corynebacterium , Listeria and Gardnerella do not form spores.
• Endospores can survive alchol and temperatures upto 150C.
• They are generally highly resistant to pH and drying, chemicals etc.
• Adequate water and optimum temperature will

D - mesangial deposits
2. It causes recurring episodes of microscopic or gross haematuria lasting a few days. Usually recurs every few months after the onset. Can present as microscopic haematuria as well.
1. in PSGN, the haematuria develops 1-2 weeks after the respiratory infection.
6. Hallmark is IgA deposition in the mesangium. (Mesangial deposist are granular deposits)
10. Progression to CKD is slow (if at all - occurs in about 40 of cases)
1. If CKD occurs, the treatment is kidney transplant, BUT recurrent IgA deposition in the allograft is common.
6. Apparently presence of macroscopic haematuria is a good prognostic factor because patients present earlier.
Summary: ACEi / ARB -> SGLT-2 inhibitor -> Steroid as last line with poor resolution

• Commonest cause of type 4 RTA in adults is hyporeninemic hypoaldosteronism which is seen in diabetic nephropathy. (destruction of JG apparatus due to vascular hyalinosis)
• Commonest causes of type 1 RTA in adults are autoimmune diseases.

• Chronic mucocutaneous candiasis, hypoparathyroidism and hypoadrenalism (Addison's disease).
• Mnemonic: ACC (Addison's, low calcium, candidiasis)
• Addison's disease, thyroid disease (⬆/ ⬇), Type 1 Diabetes
• Mnemonic: (ATT) (T for type 1 DM)

McArdle's disease

• Muscle pain
• Cramps
• Autosomal
• Recessive
• Deficiency of Mycophosphorylase - decreased muscle glycogenolysis
• Low lactate
• Exercise related - "second wind phenomemon".
  • Marked improvement in fatigue and drop in heart rate after the initial few minutes of exercise.

#autosomal-Recessive